On the Ethics of Organ Transplantation: A Catholic Perspective The report of a working party B On the Ethics of Organ Transplantation: A Catholic Perspective © The Anscombe Bioethics Centre 2014 Design and Typesetting by Liaison Design. Nihil obstat: Rev David Goodill OP, STLic (Censor Deputatus) Imprimatur: + Bernard Longley, Archbishop of Birmingham 8 April 2014 On the Ethics of Organ Transplantation: A Catholic Perspective C Contents Foreword ......................................................... 1 Members of the working party ....................................... 2 Introduction ....................................................... 3 I. Live donation ................................................... 4 1. Current practice, legal structure and professional guidance in the United Kingdom and Ireland ............................... 4 2. Ethical issues .................................................. 5 i. The goods of transplant medicine ............................... 5 ii. Is it in principle acceptable? ................................... 5 iii. Limits to acceptability ........................................ 6 iv. Payment, remuneration, and exploitation ......................... 7 v. Is live donation ever a duty? ................................... 8 vi. Taking organs and tissues from children .......................... 9 vii. Altruistic donation .......................................... 10 viii. Paired and pooled donation and donation with restricted use . 10 ix. Domino donation ........................................... 11 x. Less than ideal donors ....................................... 12 xi. Consent for research on tissue in biobanks and possible commercialisation ........................................... 13 II. Post mortem donation ............................................ 15 1. Current practice, legal structure and professional guidance in the United Kingdom and Ireland..................................... 15 2. Ethical and philosophical issues................................... 16 i. Goods of transplant medicine .................................. 16 ii. Catholic teaching on the definition of death ....................... 16 iii. Diagnosing death by neurological criteria ......................... 17 iv. Elective ventilation .......................................... 20 v. Diagnosing death by circulatory criteria ........................... 21 vi. May hearts be transplanted after diagnosing death by circulatory criteria? .......................................... 24 vii. Consent for ante mortem procedures ............................ 24 viii. Diagnosing death in children .................................. 25 ix. Consequences in relation to different organs ...................... 25 D On the Ethics of Organ Transplantation: A Catholic Perspective x. Consequences for donors, recipients, and healthcare professionals . 26 xi. Consent and presumed or ‘deemed’ consent ...................... 28 xii. Consent in children and those with incapacity ..................... 30 xiii. Payment and other incentives to donate .......................... 31 xiv. Is post mortem donation ever a duty? ............................ 31 xv. Distribution of organs ........................................ 32 xvi. Use of fetal and embryonic tissue and cell lines ..................... 32 xvii. Consent, use of and payment for human tissue products . 34 xviii. Use of nonhuman and admixed tissue ........................... 34 xix. Transplantation of brain and generative tissue ..................... 35 xx. Donation of tissues other than for therapy ........................ 36 III. Conclusion ...................................................... 38 Glossary .......................................................... 40 Bibliography ....................................................... 45 Appendix I: On the Donation and Transplantation of Organs. Pastoral Exhortation of the Spanish Bishops’ Conference (25 October 1984) ...................................... 49 Appendix II: Pope John Paul II Address to the 18th International Congress of the Transplantation Society (29 August 2000) . 53 Appendix III: Commission of the Bishops’ Conferences of the European Community (COMECE) Ethical Aspects of Organ Donation (11 October 2007) ...................................... 57 Appendix IV: Proposals for Legislation on Organ and Tissue Donation: A Welsh Government White Paper: A joint response on behalf of The Roman Catholic Church in Wales, The Church in Wales, and the Wales Orthodox Mission (23 January 2012) ...................................... 63 On the Ethics of Organ Transplantation: A Catholic Perspective 1 Foreword In the words of Pope John Paul II, ‘We should rejoice that medicine, in its service of life, has found in organ transplantation a new way of serving the human family.’ The Catholic Church is clear that, in itself it is a good and meritorious thing to donate our organs after we are dead. Even while we are alive, actions such as giving blood can be a powerful expression of human solidarity and of Christian charity. Such actions can help build a culture of life, a culture in which life is cherished. At the same time, organ transplantation involves a complex set of practices. These raise ethical questions that require both technical scientific knowledge and careful philosophical and theological analysis. One example, explored in this Report, is the question of how to diagnose death and, more deeply, what we mean by human death. When can we say with moral certainty that the soul has departed, that the person is no more, and what remains is no longer a living human body? The Church is a sure guide on matters of faith and morals, but to apply this faith in practice we also need knowledge of the world. It is a challenge for each new generation to apply the unchanging truth of the Gospel to the changing world in which we live. This Report has been compiled by theologians, philosophers, and Catholic clinicians. It is a valuable contribution to contemporary Catholic reflection on the ethics of organ transplantation. The Report focuses particularly on the practice of organ donation as it occurs in Britain and Ireland, but many of the issues it raises seem to be of general application. It is a strength of the working group that it included members from the United States, Australia, and Spain as well as from the United Kingdom. I welcome this report as a source of reflection to help Catholics, and men and women of good will, to examine the ethical issues that surround organ transplantation so they come to an informed choice. I hope it will also be of use to healthcare professionals in reflecting on their practice, to practice ethically in the service of the human family. The value of the Report is as much in the questions it asks as in the answers it gives, and I would encourage readers to consider these questions seriously and then to follow their own best judgements. The donation of our organs is not something that can be presumed, for then it would no longer be donation, but something for each person to consider and to discuss with those close to them. It is part of the Catholic tradition to be mindful of death and to prepare for it. Part of this preparation is to think about what will happen afterwards and what effect our death may have on others (not leaving unresolved conflicts, making a will, the disposal of our remains). In a world where people avoid serious discussion of death part of the Church’s contribution is to encourage and enable such discussions. Archbishop Peter Smith Chair, Department of Christian Responsibility and Citizenship, Catholic Bishops’ Conference of England and Wales 2 On the Ethics of Organ Transplantation: A Catholic Perspective Members of the working party Rev Dr Michael Jarmulowicz (chair), MB BS (London), BSc (London), FRCPath, KSG, Pathologist, London UK Prof David Albert Jones (secretary), MA (Cantab), MA, MSt, DPhil (Oxon), Director, Anscombe Bioethics Centre, Oxford UK Rev Dr Nicanor Austriaco, OP, BSE, STB, MDiv, STL, PhD, STD (cand), Molecular Biologist and Bioethicist, Providence USA Dr Rupert Beale, MB BChir, PhD, MRCP, Clinical Lecturer in Nephrology, Cambridge UK Dr John Curran, MB, PhD, FRCA, Anaesthetist, Nottingham UK Prof Pedro Errasti MD, PhD, Professor of Nephrology and of Organ Transplantation, Navarre Spain Mr Oswald N Fernando FRCS(Eng), FRCS(Edin), Emeritus Consultant Transplant Surgeon, London UK Rev Nigel Griffin, BSc, DipTh, MA, Parish Priest and Former Hospital Chaplain, London UK Dr Dermot Kearney, MB BCh, BAO (NUI), MD (NUI), MRCPI, Cardiologist, Gateshead UK Prof Patrick Lee, BA, MA, PhD, John N and Jamie D McAleer Professor of Bioethics, Steubenville USA Prof Neil Scolding, PhD, FRCP, Burden Professor of Clinical Neurosciences, Bristol UK Prof Nicholas Tonti-Filippini, BA (Hons), MA (Monash), PhD (Melb), FHERDSA, KCSG, Bioethicist, Melbourne Australia On the Ethics of Organ Transplantation: A Catholic Perspective 3 Introduction The Catholic Church has played a significant role in the rise and maintenance of consensus on the ethical character of organ transplantation. The highest rates of organ donation in the world occur in European countries with a strong Catholic heritage1 and Catholicism seems to be positively associated with rates of donation2, especially among those who are aware of the Church’s teaching in this area3. Support and encouragement for the practice of organ donation has been expressed repeatedly by popes4 and also by national hierarchies. This teaching is also